Booked Initial Appointment with PBH Carelon Clinician

Carelon Book Initial Appointment
Clinician Profiles
Available Appointments by Insurance:
One client appointment per clinician
All Clinicians:
Available Clinician Appointments:

Clinician: A - GClinician: H - NClinician: O - TClinician: U - Z
Book Immediate Initial Appointments
Guadalupe Cervantes-Ortiz, LMFT
Maria Estante, LMFT
Martha Hernandez, LMFT
Marisela Leach, LMFT
Araceli Bejar Lua, LMFT
Carmen Magana, LMFT
Carmen Magana, LMFT
Client Information
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Person entering the information.
Client Name*

First NameLast Name
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Client Email*
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Client Date of Birth*

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Client's sex per insurance policy*
Payment Method
What is the method of payment?*

Insurance CoverageSelf-pay.

Insurance Representative

PBH will send confirmation for both scheduled and completed appointment.
Insurance Representative Name
Receive Appointment confirmation
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(Client or Guardian or Insurance Representative)
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Date Submitted*

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Date
Electronic Signature*

I understand and consent to submitting my information online to initiate services. I have reviewed and agree to the provided the Minimum Necessary for Confirmation of initial appointment. I also consent to receiving electronic communications regarding my account and services. Your contact information will be shared with Psychological Behavioral Health Inc and Psychological Behavioral Team Inc for communication purpose
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Carelon Book Initial Appointment